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      Morphologic Characteristics of Aortic Valve Sclerosis by Transesophageal Echocardiography: Importance for the Prediction of Coronary Artery Disease


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          Aortic valve sclerosis (AVS) is associated with myocardial infarction and mortality. Since it is not cost effective to test all patients with AVS for coronary artery disease (CAD), the identification of high-risk patients is important. We developed a morphologic classification system for AVS by transesophageal echocardiography and correlated the subtypes of AVS with the presence of cardiovascular disease. AVS in general was not associated with CAD. However, among patients with mixed nodular and diffuse AVS, the prevalence of CAD and previous coronary artery bypass graft surgery were higher than among those without this mixed type (p = 0.02 and 0.008, respectively). We concluded that the finding of mixed nodular and diffuse AVS identifies patients at increased risk for CAD. Thus, the echocardiographic assessment of AVS morphology is of clinical relevance.

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          Most cited references 6

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          Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study)

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            Association of mitral annulus calcification, aortic valve sclerosis and aortic root calcification with abnormal myocardial perfusion single photon emission tomography in subjects age < or =65 years old.

            We examined the hypothesis that mitral annulus calcification (MAC), aortic valve sclerosis (AVS) and aortic root calcification (ARC) are associated with coronary artery disease (CAD) in subjects age or =2) calcium (or sclerosis) deposits with diabetes or multiple (> or =2) coronary risk factors were significantly associated with abnormal SPECT in women age 55 years old (OR, 10.00) and in men age < or =55 years old (OR, 5.55). Multivariate analyses identified multiple calcium deposits as a significant predictor for an abnormal SPECT in women (p < 0.001), younger subjects age < or =55 years (p < 0.05) and the total group of subjects (p < 0.01). When coronary risk factors are also taken into consideration, the presence of multiple calcium deposits in the mitral annulus, aortic valve or aortic root appears to be a marker of CAD in men < or =55 years old and women.
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              Factors leading to progression of valvular aortic stenosis.

              The rate of progression of aortic stenosis (AS) in adults is variable. To determine whether clinical or echocardiographic variables are associated with more rapid hemodynamic progression, we identified 91 AS patients (initial valve area or = 6 months. From the first study, left ventricular dimensions and AS severity were measured by standard Doppler-echocardiographic methods. Each aortic valve was graded for severity of calcification and degree of restricted leaflet motion; the sum of these grades provided a severity index reflecting leaflet pathology. Clinical and electrocardiographic variables were abstracted from medical records. Mean age was 68 years (range 29 to 89) and 61 were women. Initial AS severity ranged from an aortic valve area of 0.6 to 2.0 cm2 (median 1.3 cm2). During a mean follow-up of 1.8 years the aortic valve area decreased 0.04 cm2/year. The patient group with more rapid progression (decrease in aortic valve area > or = 0.1 cm2/year) had a larger proportion of men (p <0.01) and patients with an elevated serum creatinine (p = 0.04), a higher left ventricular mass index (p = 0.01), and a higher severity index (p <0.001). Multivariable regression analysis identified the severity index (direct relation) and the initial aortic valve area (inverse relation) as the only independent variables associated with more rapid progression. In conclusion, the rate of AS progression, although highly variable, is more rapid when leaflet calcification is more marked.

                Author and article information

                S. Karger AG
                November 2002
                07 November 2002
                : 98
                : 3
                : 154-158
                aCedars-Sinai Medical Center, Los Angeles, Calif., bMayo Clinic, Scottsdale, Ariz., and cVeterans Affairs Medical Center, Albuquerque, N. Mex., USA
                66314 Cardiology 2002;98:154–158
                © 2002 S. Karger AG, Basel

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                Page count
                Figures: 3, Tables: 4, References: 14, Pages: 5
                Noninvasive and Diagnostic Cardiology


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